Chapter 3: Working with your vulnerabilities
The importance of clear boundaries
The importance of clear boundaries
Boundaries are the physical and emotional limits that exist between you and your patients and families. Boundaries are essential because they establish and maintain a trusting, professional relationship and can help prevent compassion distress. In determining and maintaining your personal boundaries, you will want to ensure you preserve a balance without being too rigid but also not too fluid.
If your boundaries are too rigid, you may come across as uncaring and detached.
If boundaries are too fluid, you may have difficulty separating yourself from the situation, which can interfere with your doing your job well.
Key boundaries in ICU
Below are some of the many examples you may encounter while working in ICU. Click on each example to read more.
You may be inclined to be more lenient or accept certain behaviours, or to act in certain ways you otherwise might not (e.g., not setting limits with a family member who is verbally abusive or threatening).
A deeper relationship between you and the family than is the norm may develop.
Family members may have difficulty saying goodbye or may wish to continue to have a relationship with you after the death. You may even have similar feelings yourself and find yourself conflicted between the natural pull you feel towards the family and the boundaries your training prescribes.
You may feel uncomfortable about these feelings or the tension they create, and you may want to dismiss or minimize them. Find a way to set boundaries while respectfully acknowledging the intimacy, which is real and yet specific to the particular circumstances.
Contemplations for Clinicians
Am I behaving differently than I would in any other case?
If I'm going the extra mile for a patient or family, am I serving my interests of that of the family?
In the midst of intensity and time constraints in ICU, you may have little or no time to consider the finer points of professional boundaries.
The following questions may help guide you BEFORE you’re confronted with boundary issues in working with patients and families in the ICU:
How far am I willing to go for a family?
What are the boundaries that define my personal and professional comfort?
When do I know my boundaries are being crossed?
What would I have to say no to?
What would be a situation where I could not say no and what would be the justifiable reason (e.g. the psychosocial needs are urgent)?